Pharm Tech Minutes 2011.06.28-29

High-Priority Workpackages: Status overview

• Workflow/XDW (Jürgen)
• Query Current Medication (Jose)
• Use-case: Community – Hospital, Step 1 (Orlando)
• HMW Exceptional cases, Step 1 (Marc, Leonidas)
• CMPD Exceptional cases, Step 1 (Jürgen, Leonidas)

CMPD & XDW

On XDW :

• the standard used for the structure of the Workflow Document (no CDA2, but XML schema)
• the concept of the “step” evolves into concept of “task”, which allow the manage of the status and history of the task
• the use cases part in vol1. This part has been simplified, maintaining only one general use case. The previous use cases, that there were in the previous version of the document, will be developed in collaboration with the specific domains and inserted into an implementation guide.

For CMPD :

• These new evolutions of the XDW profile gives more flexibility to the Workflow Document.
• It's responding also to the needs of the Pharmacy Domain about

• the structure of the document,
• the integration with the Community Pharmacy Manager
• the definition of the workflow in the CMPD Profile.

Decision :

• XDW's use will be mandatory.
• CMPD will be republished as a new version, a v2.

Query current medication

The work is organized by Jürgen in a mindmap.

Decision :

Write a whitepaper on Medication Reconciliation after this mindmap.

Will complete the PCC RECON profile.

Supply Chain

Introduction

Slides(pdf) by Simon

Use cases in

• Pharmacist says “OK, I have some remarks but I cannot refuse this prescription”
• Dispense directly after prescription
• Replacement of one item in the prescription

To do

For Jacqueline, one short paragraph to promote the participation of the people in IHE-related activities. Ex: [Flora Giorgio] To whom it may concern,

Recently, the IHE Pharmacy committee has come forward with Technical Frameworks for Hospital Pharmacy and Community Pharmacies. This is an important step to interoperable IT solutions for the Pharmacies, by allowing

• Lower design, development and installation costs
• Higher integration and expansion possibilities
• Positive competition and freedom of choice across vendors

Given the high awareness of the benefit of IT solutions and the pressing need for standardization we expect these frameworks to have a very positive impact in healthcare operations, both for vendors and for users, with the end result of increased efficiency of healthcare.

It is now very important to reinforce the standards by getting additional participation and feedback. By supporting the active collaboration of users and vendors, the communities will have short term benefits – knowledge dissemination – and longer-term benefits – increasing patient safety and cost efficiency of healthcare in hospitals and community pharmacies.

We therefore invite you for bringing your effort towards…

We are now at the phase of getting additional in

Discussion

Charles’s comments:

1. Good to use the model for promoting HMW, Supply and promote both. Conclusion: Add color coding to the chart to separate two dimensions

2. Second picture is just a zoom in of the model. Action: Adjust the picture?

3. HIMSS slide: HMW needs to be tested in US.

2 actions:

• Drive HIMSS to accept HMW market, proving that it supports many workflows and also the automation and supply concerns.
• Exposing the profile and look at vendors that will use it. Look at someone that can identify the target vendors. Charles mentions Scott Robertson can help. Get feedback from vendors that implemented it, make a 1-2 page presentation of the profiles.

Action: clarify the interaction between HMW and supply chain.

Naming: Supply Chain Logistics

Critical condition for CAT US: Tests in Gazelle

Next steps:

Organize a TCON (end of July) to present the paper with scenarios for the vendors and users and interested parties.

• How to contact all vendors:

• Scott to give names about vendors in US;
• Users: Jacqueline
• Phast, others?

• Content:

Jose to prepare proposal to ITI.

HMW exceptional use cases

Hospital Dispense for inpatients and outpatients

Use cases

1. Prescription is not validated by pharmacist This should not happen, or at least not block the process. There is always a validation, even if “dummy” validation.

1a. Prescription is refused Message back to prescriber. Hospital : Yes Community : Yes

2. Validation is changed by another pharmacist 2nd pharmacist changes the status. 2nd pharmacist informs 1st pharmacist (and optionally the prescriber if the pharmacists disagree). Can we have 2 advices for a same prescription? Medication Dispenser receives the refusal too.

3. Refusal is rejected by physician 2 options:

a. Pharmacist accepts the override

b. pharmacist refuses to dispense.

Prescriber will receive notification and update the prescription or create a new prescription or cancel the prescription

4. Validation is revoked but dispensing has started Message back to prescriber and dispenser. The dispenser will stop dispensing if possible. (Withdrawal of dispensing is not covered yet).

5. Validation is revoked but administration has started Message back to prescriber and dispenser and administration informer. The administration informer should stop any in process / further administrations.

6. Cancellation of a prescription Message to the pharmaceutical advisor. Hospital : Yes Community : Yes

7. Cancellation of a prescription but administration has started. The prescription placer informs the pharmaceutical advisor. The pharmacy informs the dispenser, and the dispenser informs the nurse. The administration informer should stop any in process / further administrations.

If Adv Presc notification is used, nurse can be informed immediately

8. Cancellation of a validation (different than Validation update to “Not OK”), before any dispensing starts. Same as case 2. All actions are recorded even if there is a mistake.

8a. Cancellation of a validation after dispense is started

Same as 4

8b. Cancellation of a validation after administration is started

Same as 5

9. Cancellation of an administration Same as 10. Prescription placer is informed, pharmaceutical advisor and dispensed

10. Update of an administration Prescription placer is informed, pharmaceutical advisor and dispensed

Hospital : Yes Community : No

11. There is no validation, but it is dispensed anyway

TBD

12. Emergency administration

TBD